title: Anti-actin IgA antibodies identify celiac disease patients with a Marsh 3 intestinal damage among subjects with moderate anti-TG2 levels.
abstract: A new diagnostic tool (algorithm-1) for coeliac disease (CD) permitting the diagnosis without performing the duodenal biopsy has been recently proposed by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). It combines symptoms associated with CD, high anti-transglutaminase type 2 antibody (anti-TG2) levels, anti-endomysium-IgA antibodies (EMA), and at-risk HLA. Our aims were (i) to evaluate retrospectively in 227 individuals (149 CD patients and 78 controls) the algorithm-1, (ii) to reduce the number of duodenal biopsies among CD patients for whom algorithm-1 is not applicable through the addition of antiactin IgA antibodies (AAA-IgA), and (iii) to evaluate prospectively algorithm-1 and AAA-IgA in 50 patients with suspected CD. Algorithm-1 identified 70 out of 149 CD patients with Marsh 3 lesions. Adding AAA-IgA to the remaining patients with anti-TG2 levels comprised between 4 and 10 times upper limit of normal (ULN) allowed the detection of further 20 patients with a Marsh 3 damage. In our prospective study, algorithm-1 identified 23 out of 50 patients, whilst further 7 were recognized adding AAA-IgA. We confirm that algorithm-1 may avoid the duodenal biopsy in many CD patients and underscores the usefulness of AAA-IgA in reducing the number of duodenal biopsies in patients with moderate anti-TG2 levels.
authors.affiliation: Department of Public Health, University of Cagliari, Cittadella Universitaria, Monserrato, 09045 Cagliari, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Schirru
authors.forename: Fabrice
authors.initials: F
authors.lastname: Danjou
authors.forename: Lucia
authors.initials: L
authors.lastname: Cicotto
authors.forename: Rossano
authors.initials: R
authors.lastname: Rossino
authors.forename: Maria Doloretta
authors.initials: MD
authors.lastname: Macis
authors.forename: Rosanna
authors.initials: R
authors.lastname: Lampis
authors.forename: Rita-Désirée
authors.initials: RD
authors.lastname: Jores
authors.forename: Mauro
authors.initials: M
authors.lastname: Congia
mesh_terms: D000199:Actins / Q000276:immunology*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology*; D002648:Child; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007422:Intestines / Q000276:immunology* / Q000473:pathology*; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012016:Reference Values; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D000199:Actins; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins